In ordinary conversation, nearly any mood with some element of sadness may be called ‘depressed’. However, for depression to be termed Clinical Depression, it must reach criteria which are generally accepted by clinicians; it is more than just a temporary state of sadness. Generally, when symptoms last two weeks or more, and are so severe that they interfere with daily living, one can be said to be suffering from clinical depression. Using DSM-IV-TR terminology, someone with a major depressive disorder can, by definition, be said to be suffering from Clinical Depression.

 

Clinical Depression affects about 16% of the population at one time or another in their lives. The mean age of onset from a number of studies is in the late 20s. About twice as many women as men report or receive treatment for Clinical Depression, though the gap is shrinking and this difference disappears after menopause. Clinical Depression is expected to become the second leading cause of disability worldwide (after heart disease) by the year 2020 according to the World Health Organisation.

 

According to the DSM-IV-TR criteria for diagnosing a major depressive disorder - http://www.behavenet.com/capsules/disorders/mjrdepd.htm -  one or both of the following two required elements need to be present:-

• Depressed mood or
• Loss of interest or pleasure

 

It is sufficient to have either of these symptoms in conjunction with four of a list of other symptoms, these include:-

• Feelings of overwhelming sadness or fear, or seeming inability to feel emotion.
• Marked decrease of interest in pleasurable activities
• Changing appetite and marked weight gain or weight loss
• Disturbed sleep patterns, either insomnia or sleeping more than normal
• Changes in activity levels, restless or moving significantly slower than normal
• Fatigue, both mental and physical
• Feelings of guilt, helplessness, anxiety, and/or fear
• Lowered self-esteem
• Decreased ability to concentrate or make decisions
• Thinking about death or suicide

 

The diagnosis does not require "loss of interest in life, anhedonia". Likewise, "lack of energy and motivation" is not at all a required symptom of a major depressive episode.

 

Improper drug or alcohol use is not a diagnostic symptom, but often accompanies and may be a causal factor in Major Depression.

 

Andrew Solomon in his book ‘The Noonday Demon’ (p.20, Scribner, 2001)) states that the DSM IV list of symptoms is, "entirely arbitrary [and] having slight versions of all the symptoms may be less of a problem than having severe versions of two symptoms".

 

                                                                                                          Cognitive Factors

The link between negative thinking and Depression was demonstrated by Rachel Grazioli & Deborah Terry (2000) in a study in which they assessed the cognitive vulnerability of 65 women in the third trimester of pregnancy and compared that assessment with which of the women suffered Post-natal Depression. Those with high levels of negative thinking were more likely to suffer Post-natal Depression.

 

Myriam Gallardo Perez, Rosa Rivera, Amparo Belloch Fuster & M Ruiperez Rodriguez (1999) compared selective attention in depressed persons with non-depressed participants in whom a sad mood had been induced by playing miserable music and recalling unhappy memories. Participants were given a Stroop Task involving unhappy stimuli. This involved naming the ink colour in which each of a sequence of words was written. The task required the participants to pay attention to the ink  colour rather than the words. (Most people find this difficult and the words they pay attention to can reveal much about their state of mind.) The major depressive group, but not the sad mood-induced participants, paid significantly more attention to unhappy words in the Stroop Task. This indicates that attention works differently in Depression.

 

J H Yost & Giff Weary (1996) compared 58 depressed and 57 non-depressed university students on a standard correspondent inference task. The depressed students  had much less of a tendency to make internal attributions. This, Yost & Weary suggest, is because depressed persons are significantly more likely to see people as victims of circumstance – ie: pretty helpless.

 

However, Terri Wall & Jeffrey Hayes (2000) assessed  Depression and attributional style in 160 clients of a university counselling service. They found that the depressed clients tended to make internal attributions for anything that went wrong in their own lives.

 

This external attribution for others in difficulties but internal attribution for their own problems fits with much of Aaron Beck’s (1976) work around the Cognitive Triad.

 

                                                                                                       Depression in children

This is not as obvious as it is in adults; symptoms children demonstrate include:

· Loss of appetite.

· Sleep problems such as nightmares.

· Problems with behavior or grades at school where none existed before.

· Significant behavioral changes; becoming withdrawn, sulky, aggressive.

 

In older children and adolescents, an additional indicator may be the use of drugs or alcohol. Moreover, depressed adolescents are at risk for further destructive behaviours, such as eating disorders and self-harm.

 

                                                                                                      Facing up to Depression

It is hard for people who have not experienced Clinical Depression, either personally or by regular exposure to people suffering it, to understand its emotional impact and severity, interpreting it instead as being similar to "having the blues" or "feeling down". As the list of symptoms above indicates, Clinical Depression is a syndrome of interlocking symptoms which goes far beyond sad or painful feelings. A variety of biological indicators, including measurement of neurotransmitter levels, have shown that there are significant changes in brain chemistry and an overall reduction in brain activity. One consequence of a lack of understanding of its nature is that depressed individuals are often criticised by themselves and others for not making an effort to help themselves. However, the very nature of Depression alters the way people think and react to situations to the point where they may become so pessimistic that they can do little or nothing about their condition. Because of this profound and often overwhelmingly negative outlook, it is imperative that the depressed individual seek professional help. Untreated Depression is typically characterised by progressively worsening episodes separated by plateaus of temporary stability or remission. If left untreated it will generally resolve within six months to two years although occasionally Depression becomes chronic and lasts for many years or indefinitely. In many cases (but not all) treatment can shorten the period of distress to a matter of weeks. While depressed, the person may damage themselves socially (eg: the break up of relationships), occupationally (eg: loss of a job), financially and physically. Treatment of Depression can significantly reduce the incidence of this damage, including reducing the risk of suicide which is otherwise a common and tragic outcome. For all of these reasons, treatment of Clinical Depression is seen by many as very useful and at times life saving.

 

Some people can experience anhedonia for long periods of time before they discover it is a mental illness. The inability to feel pleasure can advance negativity already present in a depressed person's mental state.

 

 

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